Commentary: This commentary was challenging and relentless

Central MessagePulmonary vein stenosis is a challenging and relentless disease.See Article on page 2169. Pulmonary disease. See Most reports the subject pulmonary (PVS) begin with admonition that this disease or Vanderlaan colleagues1Vanderlaan R.D. Rome J. Hirsch R. Ivy D. Caldarone C.A. stenosis: treatment challenges.J Thorac Cardiovasc Surg. 2021; 161: 2169-2176Abstract Full Text PDF Scopus (7) Google Scholar remind us once again of simple fact. According to Society Thoracic Surgeons Congenital Heart Surgery database, there are approximately 150 operations performed annually in United States Canada for PVS 115 centers. That means, course, most centers performing 1 2 such annually. This underscores importance developing network interested parties study diagnosis. represent group provide valuable addition literature summarize knowledge date. What exactly can we learn by reading their article?•Do know what causes PVS? The answer no. Apart from some interesting theoretical genetic, embryologic, mechanical propositions etiology remains elusive.•Do how make diagnosis? yes! recommendation start an echocardiogram (no surprise there) then move cardiac catheterization, computed tomography magnetic resonance angiography possibly nuclear medicine perfusion scans. essentially runs gamut diagnostic tests available heart specialists.•Do best treat Sort of. Balloon dilatation stenting veins were considered hopeless harmful.2Peng L.F. Lock J.E. Nugent A.W. Jenkins K.J. McElhinney D.B. Comparison conventional cutting balloon angioplasty congenital postoperative infants young children.Cath Int. 2010; 75: 1084-1090PubMed However, stents have made comeback drug-eluting appear better than bare-metal stents, recognizing largest stent 5 mm. operation? so-called sutureless technique (it actually does require sutures) has midterm results other techniques as patch venoplasty, ostial resection, reimplantation, unroofing. recurrence rate mortality remain somewhat high. In addition, upstream proximal pericardial reflection would much more complex operation intraoperative placement. After all, relentless.•What indications placement surgery? question rarely answered articles regarding unfortunately do not any insight. A symptomatic patient severe involving all 4 hypertension clearly should intervention. But about asymptomatic patients normal right ventricular pressure single stenotic vein?•What medical therapy? few clinical trials drugs been performed. Those may hold promise imatinib, bevacizumab, losartan. studies hampered small numbers lack controls.•What if nothing working? Lung transplantation final solution, 5-year survival around 50%. conclude this? Perhaps new, innovative procedure will be developed. these something else found difference maker. At end day, relentless. Treatment challengesThe Journal Cardiovascular SurgeryVol. 161Issue 6PreviewPulmonary formidable challenge recent years, community pushed advance our understanding Experimental therapies, surveillance modalities, advancements surgical transcatheter interventions reviewed, emphasis current challenges facing community. Full-Text